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Can Quantification of Biceps Peritendinous Effusion Predict Rotator Cuff Pathologies?

A Retrospective Analysis of 1352 Shoulder Ultrasound

Hung, Chen-Yu MD; Chang, Ke-Vin MD, PhD; Özçakar, Levent MD; Wang, Tyng-Guey MD; Chen, Wen-Shiang MD, PhD

American Journal of Physical Medicine & Rehabilitation: March 2016 - Volume 95 - Issue 3 - p 161–168
doi: 10.1097/PHM.0000000000000442
Original Research Articles CME Article . 2016 Series . Number 3

Objective The purposes of this study were to determine the best cutoff value for bicipital peritendinous effusion (BPE) and to test its diagnostic performance as regards shoulders with and without rotator cuff pathology.

Design We reviewed the sonographic reports of 1352 patients with suspected shoulder disorders between January 2011 and June 2012. The associations between BPE and rotator cuff abnormalities were explored by logistic regression and adjusted for age, sex, affected side, and clinical diagnosis of frozen shoulder. The receiver operating characteristic curves were constructed to assess the ability of BPE to discriminate certain rotator cuff pathologies. Maximal Youden indexes were used to define the best cutoff points, which were later applied on the validation data set for its discriminative ability.

Results Sonographic findings of subscapularis tendinopathy, subdeltoid bursitis, supraspinatus full-thickness tear, and supraspinatus articular-sided partial-thickness tear were found to be associated with BPE. The cutoff values of BPE to differentiate those lesions were 1.0, 0.9, 1.5, and 1.5 mm, respectively. Validation of the diagnostic performance of BPE at defined thicknesses yielded good negative predictive values for the aforementioned rotator cuff abnormalities.

Conclusions Sonographically detected BPE seems to be in association with certain rotator cuff pathologies, and it can be utilized as an adjuvant finding to rule out such rotator cuff abnormalities.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at

CME Objectives: Upon completion of this article, the reader should be able (1) to realize the association between the biceps peritendinous effusion and other sonographic abnormal findings regarding the shoulder joint, (2) to understand the possible mechanism of biceps peritendinous effusion production, and (3) to use biceps peritendinous effusion as an adjuvant finding to rule out rotator cuff abnormalities.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C-YH); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, Taipei, Taiwan (K-VC); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (LÖ); and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T-GW, W-SC).

All correspondence and requests for reprints should be addressed to: Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch and National Taiwan University College of Medicine, 87 Neijiang St., Wanhua Dist., Taipei City 108, Taiwan (R.O.C.).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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